Expense Reports

Edit 1 …










































EMPLOYEE NUMBER:


FOR OFFICE USE ONLY
CLAIM MONTH:











MM/YY (ONE DEMAND PER MONTH)













EMPLOYEE NAME:


DEPARTMENT:






(Last Name, First Name)







EMP LOCATION ADDRESS:
 333 "C" STREET, MARTINEZ, CA

EMP PHONE #:
























TRAVEL DEMAND BY PRIVATE AUTO
EXPENSE REIMBURSEMENT

FOR AUDITOR'S USE ONLY


DATE
 FROM/TO
 PURPOSE
 MILES
DATE
 ITEM OF EXPENSE
 AMOUNT

PD TAX
 REIM TAX
 NO TAX















































































































































































































































































































































































TOTAL
 TOTAL
 TOTAL








TOTAL


TOTAL





























EXPENSE CODE 1: MILEAGE DISTRIBUTION


EXPENSE CODE 2: EXPENSE DISTRIBUTION








ORG
 TASK
 OPT
 ACTIVITY
 MILES
DATE
 DESCRIPTION
 ORG
 ACCT
 TASK
 OPT
 ACTIVITY
 AMOUNT





















































































The undersigned under the penalty of perjury states: That this claim and the items as therein set out are true and correct; That no part thereof has been heretofore paid;




and That the amount therein is justly due; and that the same is presented within one year after the last item thereof has accrued.







































































EMPLOYEE'S SIGNATURE
DATE

SUPERVISOR'S SIGNATURE
 DATE
DEPARTMENT HEAD OR DEPUTY
 DATE
















SEE INSTRUCTIONS BELOW













































All claims against Contra Costa County must be itemized, giving dates and the character of expenses








incurred. Receipts are required for lodging, public transportation (other than local), registration fees, and








items bought for others, such as meals and incidentals. Purchases for others must be identified according








to person or party and relationship to County business.
































Travel by private auto -- indicate from where and why. Only actual miles driven in the course of duties








are to be claimed. If more than one trip to the same location is made in one day, the number of trips








must be specified so the number of miles will not appear exaggerated.































Items of Expense -- claims for meals must specify the location or occasion. When a meal allowance is








claimed for overtime worked, the explanation should be "meal allowance-overtime worked" and the








number of hours.






































Cell Phones -- Employee's are required to keep records of business and personal calls.






























The verification statement on this form must be signed by the claimant. Each claim is to be approved by








the Department Head or an authorized deputy of the Department Head before filing with the County








Auditor-Controller for allowance.




































Note: Use M8154 form on the General Services Web Site. No altered form will be accepted.






























For further information, refer to Administrative Information Memo No. 9.3 and your Department Manual.




































County Auditor-Controller
















Finance Building

















Martinez, California